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Waiting is the hardest part: A woman's story of abortion in remote Alaska

SXC

Editor's Note: Regardless of one's stance on the always-contentious issue of abortion, the logistical difficulty of obtaining an abortion when living in a small, isolated community in Alaska is one that many people aren't likely to consider. Alaska Dispatch generally doesn't publish anonymously written articles, but we feel this case warrants an exception. One woman speaking so frankly about her own experience could risk serious repercussions in a small town. This piece originally ran in Tomorrow Magazine, which just published its inaugural issue. You can read more stories here.

Anonymous is an employed, insured, monogamous woman of childbearing age.



I found out I was pregnant the night of my friend Monica’s 29th birthday. Most of the women at the party had kids, and early that evening the conversation focused on babies and the act of having them. I didn’t have much to contribute. I had been on birth control since age 14. My current boyfriend Nick had told me early in our relationship that his low sperm count had contributed to the decline of his previous marriage. We’d never discussed starting a family. So I tuned out most of the party chatter. At some point, Monica brought up how sore her breasts felt from the very beginning of her pregnancy. As others commiserated, I stared into my half-glass of Riesling. I had taken out my NuvaRing earlier that week and experienced a day of spotting and persistently swollen breasts instead of my usual period. It was odd, I thought, but could probably be chalked up to hormonal irregularity. I had gone on a long vacation without Nick in December, and skipped the ring that month to save $50. In the chaos of traveling, I put it back in two days late. 

Now I was worried. While I don’t think there’s ever a convenient place to realize you might be unexpectedly pregnant, a birthday party in a remote corner of a red state has got to rank near the bottom of the list. After spending most of my life on the East Coast, I’d come to Alaska to take a career risk and experience some sort of adventure. I live in a small town, hundreds of miles from Anchorage. It’s a place with more churches than restaurants. Privacy, I’ve discovered, is a big-city luxury. Here, even buying a pregnancy test is an ordeal. I made up a ridiculous little lie: “Are we heading to the bar soon?” I asked Monica. “I want to swing by the store to grab cereal for the morning, and it’s about to close.”

“We’re probably going to hang here for a while, but we’re almost out of booze. It’d be awesome if you could pick some up,” she replied. That was how I ended up in the checkout lane at the general store with a box of wine, a fifth of vodka, and a pregnancy test. The cashier, who knows me by name, avoided eye contact as she asked for my frequent-shopper number.

I stopped off at my office, between the supermarket and Monica’s house, to use the bathroom and take the test. The digital stick flashed an unambiguous “pregnant.”

I sped back to the party, dropped off the liquor, and made up a story about my little sister getting dumped and needing to talk on the phone. I got out of there and went to Nick’s apartment. It took him a couple minutes to process the news. Nick and I had been seeing each other for more than a year at this point, and I was smitten. But I never had any illusions about a future together. Nick was in his forties and planned to spend the rest of his life in this town. Meanwhile, I was a finalist for a job in Anchorage, and wanted to eventually settle in Seattle. Nick had no plans to leave the community for me, and he didn’t want me to put my life on hold for him. “So, what do you want to do?” he asked. We both knew the answer, but we went through the options anyway: Try raising a kid together, in what would probably be a dysfunctional home with at least one miserable parent. Adoption, preceded by a difficult pregnancy that would leave me feeling like the town’s Hester Prynne. Single parenthood.

Abortion.

I didn’t cry until the third day, the Monday after I found out I was pregnant. I got up at 5 a.m., well before I needed to show up to work, and called my health insurance provider to see if it would cover the cost of the termination.

As some awful Kenny G.-style hold music played on the line, I ran the numbers. At $650, an abortion would cost me what I spent on a month’s rent. That was on top of the $500 plane ticket to Anchorage and the hotel and car-rental expenses I would have to pay to get myself to the clinic. Finally, a woman picked up. I pussyfooted around my question, then came out with it: My birth control failed, and I didn’t want to go through with the pregnancy. “Yeah, you’re not covered for that,” she said brusquely.

'A logistical nightmare'

I called Planned Parenthood next. The man who took my call asked what I needed. How far along was I? No more than three weeks. Where did I live? Western Alaska. Could I travel to their Anchorage, Juneau, or Fairbanks center? (In Lower 48 terms, that’s like living in Phoenix and being asked if you would prefer flying to Dallas, Denver, or Orlando.) I said Anchorage was best. Then came the scheduling. The big challenge was finding an opening on a week when Nick and I could both travel. He had a break in early March, and I had a work trip around then that I could use as a pretext for getting out of town. We had become covert operators, doing our best to head off any questions about our personal lives. When I lived on the East Coast, the idea of becoming a social pariah for something that happened in a physician’s office was alien. I hardly knew the people who lived next door, let alone what went on between them and their doctors. Now, the possibility of being judged by nosy neighbors was a major consideration when dealing with my own health. I told the Planned Parenthood representative that March 9 would be easiest.

In a state with only eight abortion providers, making an appointment proved to be a logistical nightmare. The Anchorage Planned Parenthood clinic offers abortion services just a few days each month. It contracts with doctors in the area, working around their availability and without publicizing their identities. The man on the line said he couldn’t schedule anything more than two weeks in advance, and they only had a couple of openings. None of the dates worked for Nick and me. I would have to call back later. Still, I didn’t cry.

On my lunch hour that day, I fell into a Wikipedia hole. Hot soaks, gin, and high doses of vitamin C had all been used to induce abortion before the era of modern medicine. Excessive exercise and cocaine were both shown to increase the odds of miscarriage. Right after work, I ran five miles, then collapsed in a bubble bath with a gimlet. (I stopped short of trying to find a coke dealer.) Of course, I didn’t expect anything to happen -- this was a gesture, a grasp at control. As I stepped out of the tub, I nearly fainted. At only a few weeks pregnant, my blood was already thickening and the water’s heat left me weak and dizzy.

When I went over to Nick’s for dinner later, I made it through three bites before bawling into my pad thai. What if I couldn’t get an appointment? What if he couldn’t be there? Would the Planned Parenthood staff have to throw me in a cab at the end of the surgery? Would there be picketers? What if people in town found out about the pregnancy? Why was my body being so weird? What was this going to do to my savings?

Fuck my insurance, Nick said. He’d cover the costs. And he would find a way to be there with me in February if that was the only time I could get an appointment. As far as everything else, well: one problem at a time.

Over the next week and a half, I called Planned Parenthood every day to see if their March schedule was set. The answer was always the same: call tomorrow. Finally, I gave up and took the only Friday appointment they had, on Feb. 24. I requested the day off from work and booked my plane ticket. Now, I just had to ride things out. I effectively moved in with Nick to avoid questions from my housemates about why I was always so exhausted and suddenly found the smell of food so nauseating. But turning into a recluse didn’t shield me from feeling as if the world thought I was a bad person.

You know how when you learn the definition of some obscure word, you start hearing it constantly? Planning to have an abortion was like that. Pregnancy and reproductive rights and babies were everywhere. In the morning, NPR hosts discussed the Susan G. Komen Foundation pulling support from Planned Parenthood. Before bed, it was a Daily Show monologue on the absurdity of Rush Limbaugh calling a Georgetown University law student a slut because she wanted her university insurance to cover contraceptives.

Facebook was worse. My conservative Alaskan friends were posting “abortion is murder” links. My liberal East Coast friends were sharing videos of Virginia legislators joking about transvaginal ultrasounds, something I knew I would have to go through. (A bill mandating them has stalled in the Alaska state legislature, but providers here require them in part to make sure they’re not going over the first-trimester limit.) Elementary school friends were posting baby photos. Because of my browsing history, targeted Facebook ads started asking, “Is your family expanding?” I canceled my account.

The waiting is the hardest part

My physical state wasn’t much better. In popular culture, pregnancy is pickles and ice cream. In reality, pregnancy is bile and shit. My body felt like lead, my stomach was in knots, and I got a raging urinary tract infection. All the cranberry juice in the world couldn’t have helped. I woke up at 3 a.m. to piss blood and then curl up on the bathmat. If I lived in a big city, I would have just scheduled a hospital visit, gotten some antibiotics, and been done with it. But I was terrified that, in Alaska, the medical staff would notice the presence of HCG, the hormone your body produces when you’re pregnant, in my urine sample, and my secret would be out.

I gave in after five painful days. The local clinic has three doctors: one who is deeply Christian, one who has a reputation for gossiping about patients’ sexual health after one too many drinks, and one who is a consummate professional. That last one was, fortunately, taking walk-ins the day of my visit. I explained my symptoms and asked which tests the lab would run on my sample. When I told her knew I was pregnant, and that I planned to get an abortion, she went from friendly to serious and promised that she wouldn’t include anything about a pregnancy in her notes.

After the results came back, the doctor put me down for antibiotics: Instead of a short course of Cipro, she prescribed seven days of a milder drug that wouldn’t damage the embryo inside of me. She understood I was sure about the abortion, but this was in case I changed my mind. I thanked her and went to the lobby to wait for the dispensary to fill the prescription. After half an hour, another doctor came out -- the Christian one. She was handling prescriptions, but she had a few questions first. Did I have any pre-existing conditions? Because she’d looked at my charts, and I should have been put on a three-day course of something stronger. I froze.

Probably after realizing we were in a public waiting room, she backed off. On my way out, I ran into a nurse friend of mine. Megan was done with her shift. Would I like to hang out? Yes. I told her about the UTI, the clinic fiasco, the birth control failure, and my plans to get an abortion.

“Oh, God, yeah, everyone’s had one of those,” Megan said, going into detail about the one she had in her early 20s. “I really don’t know why we don’t do them here. We’ve got ultrasound equipment and half the stuff for a medical abortion. We use the meds for ulcers, I think. I was actually thinking of getting certified for them when I go back to Washington, but you can’t do them in Alaska without an MD.”

There are two types of first-trimester abortion: vacuum aspiration, which uses suction to remove the embryo, and medication, which means you take drugs to trigger contractions and then check in with the provider a week later to ensure it worked. I was about to travel hundreds of miles for the aspiration kind, even though there was a person right here in town whom I trusted, with the equipment to do a less invasive procedure.

“I’d like to do them if we could,” the local clinic’s executive director told me in a later conversation, in which she also talked about her own abortion. But her providers, she said, are terrified of malpractice lawsuits on the slim chance anything should go wrong. “You won’t see young doctors doing it. It’ll be a 70-year-old doctor who’s not worried about combative medicine” -- her term for health care where patients are treated as future litigants. On top of that, there’s the conscience clause issue. One of the clinic’s doctors -- the one who tried to change my prescription -- has religious concerns about prescribing the pill and certainly wouldn’t provide medication abortions. And even if the providers didn’t have qualms, some very vocal members of the community would. The clinic sees no reason to fight to provide abortions to a few women a year.

Still, knowing that the supplies for it were a five-minute drive from my house made the call I got the next day even more brutal.

Communication breakdown

I got the voicemail alert at lunchtime. My Planned Parenthood appointment was canceled, but I should call back if I was interested in rescheduling. That couldn’t be. The appointment was a week away.

I returned the call immediately. After being bounced from one representative to another, I finally learned that their Anchorage provider could no longer come in. If I wanted, they could try to squeeze me in earlier that week. Everyone seemed to have a hard time understanding the fact that I lived nowhere near Anchorage. I no longer trusted Planned Parenthood to get me through this.

I found out later that those representatives weren’t actually in Alaska, but in Tacoma, Wash. -- one time zone and 2,000 miles away -- thanks to a recent merger that lumped in my state with Washington and Idaho. It was no wonder that the people I was talking to had no idea about my geographic challenges.

Part of the problem is that the reproductive health burden falls so heavily on Planned Parenthood. Alaska is a Republican stronghold, but thanks to a strong libertarian streak, it’s been historically good on abortion rights. The state has a privacy clause in its constitution, and it legalized abortion before Roe v. Wade. There were even a number of providers through the mid-1990s. But private practices stopped offering services, and they haven’t been replaced.

Planned Parenthood administrator Clover Simon thinks politics -- both new laws and social pressure -- are to blame for the limited access. Like Megan, she says the fact that only doctors can administer the pills for medication abortion isn’t good for rural women. But she also thinks that fear of malpractice suits is a weak reason for not offering them. “In-clinic abortion procedures are extremely safe,” says Simon.

With only a few more weeks to get the abortion, I started panicking. My parents, who are both doctors, were aware of my situation. They wanted me to fly home to the East Coast and get it done at the hospital where my dad worked. If I had still lived near them, it all would have been so easy. I didn’t want to travel across the country without Nick, though, and I didn’t want to take a full week off work. So I went through the short list of obstetricians who perform abortions in Anchorage. I found one who had a dedicated phone line to explain everything an abortion would involve. I scheduled an appointment with her in March.

I flew to Anchorage early, and Nick met me there the night before the abortion. That morning, we drove to the doctor’s office, one of many in a nondescript medical center. Across the street, a handful of picketers were marching in front of Anchorage’s lone Planned Parenthood, where I had so desperately tried to get an appointment the month before.

'It just is'

When I met my doctor, she did her best to put me at ease. Dr. Woods was happy to talk about how the “war on women” was affecting her practice. By the time she put me in stirrups, I felt righteously indignant. That feeling disappeared pretty fast, right around the time of the transvaginal ultrasound. I didn’t enjoy being probed with a giant wand, or hearing the 9-week-old fetus’ heartbeat. I had already gone through plenty of soul-searching, and this wasn’t going to change my mind.

I expected to be sedated for the actual abortion, but Dr. Woods only used local anesthesia. While the whole procedure took about 15 minutes, the pain left me blanched and hyperventilating. When it was done, she gave me a copy of the ultrasound photo: a little curlicue blob against black. She wasn’t required to do this. I didn’t know what to make of it.

“It isn’t good. It isn’t bad. It just is,” she said. Sweat-drenched, I sipped apple juice and lay in the exam room for a bit -- but not for too long. Another patient who had traveled miles and miles to be here was waiting for her turn.

For the next couple of days, I slept, watched Downton Abbey, and ate ice cream with Nick in an Anchorage hotel room. Then he went home, and I traveled on to Juneau for work, where I was staying in the home of an older colleague. I pretended everything was OK until we said our goodnights. As soon as I was alone, I lost it.

I spent the night sobbing, as quietly as possible, over a life I wouldn’t have with Nick. But I never once thought I had made a wrong choice. Going through with the pregnancy would have meant committing to a place where it would be just as difficult to raise a child as it was to get a basic surgery. If Nick and I had met in a big city like Seattle, I might have made a different decision.

Seven months after Monica’s birthday -- six months after the abortion -- I celebrated my own birthday with Nick, Monica, and her four-year-old girl, Abigail. I spent the meal drawing with Abigail and admiring her pink nail polish. After dessert, she started crying, so Nick lifted her and spun her around. She broke into giggles. The scene was very sweet, and I smiled. We were all doing the things we were supposed to, picking up the burdens we could lift.

A note from the author on anonymityAfter going to such aggressive lengths to shield my privacy, I want nothing more than to attach my name to this piece. I would like to be able to talk openly about going through a legal medical procedure without fearing a backlash. But that’s not the reality at this time, in this place. The reality is, it was my choice but this isn’t just my story. It’s my boyfriend’s story, it’s my friends’ story, it’s the story of the health care providers who helped me. For myself as well as for the people mentioned here, the social consequences of attaching our real names to it are just too high. So I’m publishing this anonymously, and have changed the names of everyone who isn’t speaking in an official capacity.